Common Neurological Disorders Flashcards
List some common neurological problems
- Epilepsy
- Multiple sclerosis
- Parkinson’s disease
- Sciatica
- Cerebral palsy
- Down’s syndrome
- Stroke and TIA
- Dementia
- Retinal degeneration
- Neoplasm
What can the impact of neurological diseases be
- Abnormal sensory function
- And normal motor function
- Abnormal co ordination
- Abnormal organic function
- Abnormal cognitions
Is carpal tunnel syndrome more common in men or women
Women
What is the carpal tunnel
It is where the median nerve passes in the wrist
It is formed by a ring of bones and tough tendon
What is the significance of the Median nerve
It innervated the thumb, finger, middle finger and half the ring finger closest to the thumb
What happens in carpal tunnel syndrome
Swelling can occur in the carpal tunnel leading to the compression of the median nerve
When might the carpal tunnel be swollen
- Pregnancy
- Obesity
- Structural damage to the wrist
What are some of the symptoms of carpal tunnel syndrome
- Pain
- Altered association including numbness or burning
- Decreased motor power and weak grip
How do we manage carpal tunnel syndrome
- Rest- wrist splints
- Exercises
- Drugs
- Surgical decompression
What is sciatica
Symptoms arising from the sciatic nerve
What is the sciatic nerve
The largest nerve arising from the spinal cord
What are the symptoms of sciatica
Mild back ache (minor nerve compression)
Severe pain shooting down the leg which may be accompanied with numbness and loss of motor power (major nerve compression)
What is sciatica commonly caused by
Compression of one or more of the 6-6 nerve roots arising from the distal end of the spinal cord
Most commonly due to prolapsed intervertebral disk (slip disk)
How do we manage sciatica
Rest
Surgical decompression
What is a seizure
Occurs when there is temporary abnormal electrical activity in a group of brain cells that may spread to involve other parts of the brain
What is another term for seizure
Convulsion
What is a seizure characterised by
- Range of clinical features
2. Duration of a few seconds or minutes
What can seizures be broadly divided into
- Epilepsy
2. Other seizures
What is epilepsy
A group of disorders with many different causes all of which are characterised by a tendency to have recurring unprovoked seizures
Name the different types of epilepsy
- Active epilepsy
- Refractory epilepsy
- Status epilepticus
- Other
Define active epilepsy
Occurrence of an epileptic seizure in the last 2 years
Or
Where a patient is taking medication to prevent further epileptic seizures
Define refractory epilepsy
Inadequate control of seizures despite optimal treatment
What is status epilepticus
It is rare but serious condition where epileptic seizures continue either constant or repeatedly over a period of 30 mins or more
When are we all susceptible to seizures
If the brain is subjected to certain stressful situations eg
- Fever
- Hypoglycaemia
- Withdrawal of alcohol in alcohol dependency
How common is active epilepsy
1 in 200 people have it in the uk
350,000 people
How common is refractory epilepsy
1 in 700 people in the uk
100,000 people
How is epilepsy classified
- Partial epileptic seizures
2. Generalised epileptic seizures
What are partial epileptic seizures
When Abnormal electrical activity is restricted to a focal area of the brain
What can partial epileptic seizures be further classified into
- Temporal lobes epilepsy
2. Occipital love epilepsy
What can temporal love epilepsy result in
Abnormalities of taste or smell, psychic disturbances including deja vu
What can occipital love epilepsy result in
Abnormal visual perceptions such as balls of light or coloured patterns
What can happen to partial epileptic seizures if they are untreated
Around half of partial seizures subsequently become generalised
How do some partial seizures become generalised
The abnormal electrical activity spread from a focal area to involve both cerebral hemispheres
What will happen if a partial seizure doesn’t become generalised
Patient will either have:
- No impairment of consciousness
- Impaired consciousness but not loss
What do generalised epileptic seizures reflect
Reflect abnormal electrical activity throughout the cerebral hemispheres
What can generalised epileptic seizures develop from
- Partial seizures
Or - A Discrete event without a focal onset
Name the most common form of generalised seizures
Grand mal epilepsy
What is Grand Mal Epilepsy also known as
Tonic clonic epilepsy or seizures
List the defined stages of tonic clonics
- Prodrome
- Aura
- Tonic phase
- Clonic phase
- Post-ictal phase
Describe the prodrome stage of tonic clonic
It precedes the main symptoms where it is characterised by typically vague features such as unease, irritability or non specific malaise that may last hours or days
What is the aura stage of tonic clonics
Can occur in patients who experience a partial seizure that subsequently becomes generalised
The symptoms depend on the anatomical site of the partial seizure and may include disturbances of one or more sensory modalities
What is the tonic phase of tonic clonics
Lasts only a few seconds usually and is characterised by unconsciousness, inability to maintain a normal posture which usually results in the patient falling
Absence of breathing as the best walk muscles have gone into spasms and patient may cry of grunt as it happens
Increased thoracic pressure can result in deoxygenated blood pooling in facial tissues
Tongue busting
Drooling g
Urinalysis and faecal incontinence may occur
Name the first clear indication of tonic clonic seizures
The tonic phase
Which phase follows the tonic phase
Clonic phase
What is the clonic phase
Last seconds or minutes and is characterised by generalised rhythmic muscular movements which may be quite violent and the tongue may be bitten
Patient remind unconscious
What does ictus mean
Means seizures but is usually reserved for the description of the period after a tonic clonic seizure
Describe the post-ictal phase
Last several minutes to hours and reflects a period of recovery
Initially the patient is unconscious or confused but full consciousness has usually been regained in 15-60 mins
What can the post-ictal phase be associated with
Generalised muscular aches, a sore tongue and headache, strong desire to sleep
What can epilepsy be caused by
- Genetic and congenital causes
2. Acquired diseased
List some acquired Illnesses that may lead to epilepsy
- Cerebrovascular disease
- Cerebral neoplasms
- Alcohol related brain damage
- Post traumatic brain damage
When is a diagnosis of epilepsy made
When a patient has 2 or more unprovoked seizures
What is the impact of a diagnosis of epilepsy
- Driving affected
- Employment and earning potential
- Child may have learning difficulties
4 memory loss
How can driving be affected if a patient has epilepsy
Patient must refrain from driving for one year from the date of the attack
What employment options are restricted for a patient with epilepsy
- Control of a vehicle or aircraft
- Positions in the police, armed forces or fire brigade
- Merchant seaman
What are the aims of epilepsy management
- Prevent seizures without causing unacceptable side effects due to medication or other interventions
- Optimise the patients quality of life
What to drugs for epilepsy management aim to do
Drugs aims to raise the seizure threshold and so prevent seizure initiation
What does management of epilepsy include
- Identification and where possible, correction or underlying conditions that promote seizure initiation
- Avoidance of situations that precipitate seizures
- Active intervention to reduce seizure frequency
List some medication used to manage epilepsy
- Carbamazepine
- Sodium valproate
- Phenytoin
- Lamotrigine
- Gabapentin
What influences our decision when choosing which drug to prescribe to manage epilepsy
- Seizure type
- Age
- Learning difficulties
- Complexity of the situation
What is the standardised mortality rate for epilepsy
2-3
2-3 times greater risk of dying compared to matched individuals without epilepsy
What is the death risk for a patient with refractory epilepsy
1 in 200 per year
What can the outcome following an initial seizure be
Can be predicted to some degree:
- Patients with underlying structural abnormalities are least likely to remit
- Many patient s without an obvious cause for their epilepsy have a better change of ultimately coming off mediation
- Patient s who have had 2 unprovoked seizures 65% will expedite further seizures within 4 years
What is multiple sclerosis
Is an inflammatory demyelinating disease of the CNS that is disseminated in time and space
What does dissemination in time mean
That clinics attacks occur at different points in time
What does dissemination in space mean
Means that lesions occur at different neuro anatomical sites
How common is multiple sclerosis
1 in 750 (90,000 people)
Is multiple sclerosis more common in men or women
Women are affected twice as much
What is the pathology of MS
- MS plaque
2. Infections in the pathogenesis if MS
Where and why does multiple sclerosis plaque form
Forms in the CNS as a consequence of inappropriate lymphocyte induced and macrophage mediated inflammation
What does macrophage mediated inflammation result in
Results in demyelination of t the nerve axons
This impairs nerve conduction
What is MS thought to arise due to
A combination of genetic predisposition and an environmental trigger such as viral infections
Describe the clinical features of MS
They are highly variable and change with time depending on where the plaque is and if sensory or motor nerves are affected
List some common symptoms of MS
- Weakness
- Optic neuritis
- Paraesthesia (numbness of tingling)
- Diplopia (double vision)
- Trouble passing urine (micturation disturbances)
- Vertigo
- Fatigue
- Mood disturbances
List some sensory symptoms of MS
- Dysaesthesias including off sensations
2. Neuropathic pain
List some motor symptoms of MS
- Spasticity
2. Ataxia of the limbs
What is spasticity
Spinal cord lesions result in limb stiffness
Flexor spasms
Cramps
Clonus
When is a diagnosis of MS made
Diagnosis not made until a patient has experienced clinical attacks at more than one neuroanatomical site at different times
A diagnosis of MS is made after…
One clinical attack if an MRI scan of the brain and spinal cord after the first attack identify new plaque
Why is an accurate diagnosis of MS important
To prevent:
- A patient being given an inappropriate MS label
- Delayed diagnosis
What are the aims of MS management
- Communication of accurate information
- Optimise support
- Optimise physical impairment and function
- Optimise control of pain
- Limit progression
How can we carry out symptomatic treatment of chronic problems
- Spasticity
- Oxybutynin
- Tricyclic antidepressants
- Systemic corticosteroids
- Interferon
- Cannabinoids
Talk through the different subtypes of MS
- Initially illness is categorised by a cute attacks
- Primary progressive MS
- Benign MS
What is primary progressive MS
it is characterised by a lack of remissions and rapid progression of impairment and disability
What is benign MS
Characterised by a lack of significant impairment and disability 10 years after diagnosis
What is death in MS patients usually due to
An unrelated cause
Suicide is 2-7 times more common in patients with MS
What is Parkinsonism
It is a descriptive term for a clinical state with the main clinical features of:
- Bradykinesia
- Rigidity
- Resting tremor
What is Bradykinesua
Slow movement
What can Parkinsonism caused by
- Parkinson’s disease
- Anti- psychotic disease
- Head injury
- Recreational drugs
- Cerebral atherosclerosis
- Carbon monoxide poisoning
What is Parkinson’s disease
A common neurodegenerative disorder categorised by degeneration of dopamine producing cells in the substantia nigra which results in bradykinesia, rigidity etc
In whom is Parkinson’s most common in
Middle and later life
What can Parkinson’s disease be caused by
- Dopamine in heath
- Genetic factors
- Environmental factors
Where is dopamine made
In the substantia nigra (a small area in the midbrain)
What is the significance of dopamine
It is a neurotransmitter essential to the normal working of motor pathways in the midbrain and in particular the function of the corpus striatum
What is the significance of the corpus striatum
It receives information about the position and movement of the body from several different parts of the brain
What happens to dopamine production as you get older
Falls after age if 35
What happens as dopamine levels fall
The substantia nigra starts to degenerate (also due to finished Lewy bodies)
What are Lewy bodies
They are abnormal aggregates of protein inside the dying nerve cells
What are the clinical features of Parkinson’s disease
- One side of the body is affected more than the other
2. Only one side of the body may be affected
What is bradykinesia characterised by
Finished performance of repot ice movements undertaken at a pace determined by the patient
Do all Parkinson’s patients have a tremor
No
Describe the classic form of tremor in Parkinson’s patients
A pill rolling tremor as though the patient is trying to roll an object between the thumb and first finger when the arms are at redt
List some other features of Parkinson’s disease
- Loss of postural reflexes
- Changes in facial expression
- Changes in speech
- Altered position
- Changes to walk (gait)
- Dementia
- Depression.
- Burning mouth syndrome
What are the aims of Parkinson’s disease management
- Communication of accurate information
- Optimise support
- Optimise psychical impairments and unctions
- Limit progression
What are the principles of Parkinson’s disease management
- Accurate communication of information
- Support mechanisms
- Drug treatment
- Surgery
- Emergency therapies
What drugs can we use to treat / manage Parkinson’s
- Levodopa
- Dopamine agonists
- MAOIs and COMTs
- Anti-muscarinic drugs
- Anti depressants and anti psychotic agents
What is levodopa
A pro drug that is decarboxylated to dopamine by surging neurones
Name the main alternative to levodopa
Dopamine agonists
What to MAOIs do
Reduce catabolism of dopamine in the CNS
What do COMTs do
They reduce the catabolism of levodopa in the peripheral circulation
What drugs can be used to control tremors and rigidity
Anti muscarinic drugs
What are the problems with anti muscarinic drugs
Adverse drug reactions common and include:
Urinary frequency
Blurring of vision
Xerostomia
